Provider Demographics
NPI:1063745669
Name:DYNAMIC HOME HEALTH CARE, INC
Entity type:Organization
Organization Name:DYNAMIC HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT
Authorized Official - Phone:215-870-3441
Mailing Address - Street 1:550 STATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-8702
Mailing Address - Country:US
Mailing Address - Phone:215-244-4466
Mailing Address - Fax:
Practice Address - Street 1:550 STATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-8702
Practice Address - Country:US
Practice Address - Phone:215-244-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03750501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102455620 0001Medicaid
PA102455620 0001Medicaid